Provider Demographics
NPI:1336134873
Name:MCNULTY, CANDACE MIKLOZEK (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:MIKLOZEK
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:L
Other - Last Name:MIKLOZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-688-8000
Mailing Address - Fax:775-688-8031
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-688-8000
Practice Address - Fax:775-688-8031
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6897207RC0000X
CAC43207207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016589Medicaid
NV2016589Medicaid
CAC432070Medicare PIN
NVWCGXP12Medicare PIN